Get Ready for the Obamacare Enrollment Crash

It finally looks like things are going the right way for the healthcare law, but the numbers include everyone who has selected insurance, not those who have actually paid.
Larry Downing/Reuters

Obamacare's enrollment numbers are surging—for now.

After a disastrous launch, the law's backers are breathing a sigh of relief as enrollees flock to its insurance exchanges. But the totals are built on a shaky foundation, and at some point soon, the exchange-enrollment figures are going to fall, perhaps by more than 1 million people.

Right now, the administration is counting the total number of people who have selected an insurance policy under the law, rather than the number of people who've paid for it.

But at some point, likely this spring, the administration will be forced to disclose how many people are actually paying their premiums—a more accurate yet undoubtedly lower count of who actually got insured under the Affordable Care Act.

About 20 to 30 percent of people who selected a plan did not make their first payment, according to anecdotal estimates from individual insurance companies. Those numbers aren't official or final, and could improve—but however they end up, that's the real measure of Obamacare's first-year success.

It's hard to see the revision doing any real damage to the law's long-term prospects for survival, or its potential to grow. And in real-world impact, it doesn't mean that anyone has lost their insurance; it simply means they signed up to buy a plan that, for whatever reason, they're not going to actually buy.

Politically, however, it will be a Republican field day, as it hands Republicans a fresh attack—one that undercuts Democrats' emerging success story of high enrollment—and could put vulnerable Democrats back on the defensive over a law they're trying not to talk about.

The Health and Human Services Department's latest update reported that 3.3 million people had selected an insurance policy on the law's new exchanges by the end of January. It was a positive report by almost any standard, and puts enrollment on track to hit 5 to 6 million by the time the window closes in March.

Democrats have touted the totals as a sign that the law is working, despite Republican intransigence and early technology disasters.

But if the early indications hold and the more accurate enrollment metric shaves 20 to 30 percent off the initial numbers, it will be a painful shift for Democrats. At current levels, it takes enrollment from 3.3 million down to about 2.6 million. If, hypothetically, 6 million people choose a plan by the end of March, real enrollment would be closer to 4.8 million.

That's enough for the new insurance markets to be sustainable, healthcare wonks say. The Affordable Care Act is already here to stay.

Still, the day the White House cuts its own enrollment totals by 20 percent is probably not going to be a very fun day for vulnerable Democrats, who are already frustrated with the administration over the delays and technical headaches that have riddled the implementation effort.

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Sam Baker is a healthcare correspondent at National Journal.

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